Psychometric validation of the Arabic version of the GAD-7 among Lebanese Adolescents

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Anxiety is one of the major global mental health concerns, particularly amidst accumulating adversities. It is the leading cause of distress in adolescents worldwide and has a profound deleterious impact on their mental and physical health and wellbeing. This paper seeks to identify and validate the psychometric properties of the Arabic version of the GAD-7 in Lebanon, aiming to improve the much-needed overall mental health screening in Middle Eastern countries. Methods. This study includes a cross-sectional design including 638 adolescents in Lebanese public schools. Participants aged 15–18 years were assessed using GAD-7 (anxiety), PCL-5 (post-traumatic stress disorder), and PTGi (post-traumatic growth) in their Arabic versions at two-time points, spaced three months apart. Results. Our analyses revealed that the 7 items of the GAD-7 converged into a single factor. Composite reliability of scores was adequate in the total sample (ω = .88 / α = .87). The convergent validity for this model was satisfactory. Results showed invariance across gender at the configural, metric, and scalar levels, with males showing a higher level of wellbeing compared to females. The pre-posttest assessment for the GAD-7 scale was conducted on 359 participants; the intraclass correlation coefficient was adequate 0.83 [95% CI .79; .86]. Our analyses also show that anxiety symptoms were significantly correlated with higher PTSD ( r = 0.68; p < .001) and lower PTG ( r = − .12; p = .004). Conclusion The Arabic GAD-7 among Lebanese adolescents displayed highly satisfactory psychometric properties, underscoring its validity. This scale could be valuable for educators and clinicians as a screening tool to rapidly detect anxiety among this vulnerable age group as GAD-7 is easy-to-use, easy to understand, culturally sensitive for Arab population and age appropriate for 15–18-year-old students. Anxiety psychometric validity PTSD adolescence Figures Figure 1 Introduction Anxiety disorders represent a prevalent mental health challenge globally, affecting people of all ages and backgrounds. In particular, during adolescence and young adult years, adolescents are prone to mental health problems. ( 1 ) Anxiety disorders can significantly impair an individual's ability to function in daily life, impacting relationships, academic performance, and overall wellbeing. ( 2 ) According to the World Health Organization, Generalized Anxiety Disorder (GAD) is a mental health condition characterized by excessive and persistent worry or anxiety about various aspects of life, such as work, relationships, health, or everyday situations. ( 1 ) The DSM-5 defines general anxiety disorder as an excessive worry about particular events or performance occurring on most days than not, for more than six months. ( 3 ) The worry is difficult to control and is often accompanied by symptoms such as restlessness, irritability, muscle tension, difficulty concentrating, and sleep disturbances. ( 1 ) Despite the significant impact of anxiety disorders on the adolescent population, these are often under-diagnosed and untreated. ( 1 ) Recently, it has been suggested that care might be improved if clinicians used standardized questionnaires to identify patients with previously unrecognized anxiety disorders. A systematic review of screening tools conducted by Herr and her colleagues ( 4 ) revealed that the GAD-7 had the best performance characteristics for identifying anxiety disorders in comparison to other measures. The GAD-7 stands out for its brevity and practical utility, with only 7 items as opposed to the Pediatric Anxiety Rating scale (50 items), ( 5 ), the State-Trait Anxiety Inventory for Children (20 items), ( 6 ) and the Revised Children’s Manifest Anxiety Scale (49 items). ( 7 ) GAD- 7 has strong psychometric properties, minimal overlap with scales measuring mental distress and might be completed by an adolescent in less than two minutes. ( 8 ) In addition, GAD-7 can be employed as a standardized cross-cultural measurement tool as it has been used in the adolescent population in many countries such as Spain, ( 9 ) Hong Kong, ( 10 ) China, ( 11 ) South Africa, ( 12 ) and Ghana, ( 13 ) among others. The GAD-7 has even been used in the clinical adolescent population with migraine, ( 14 ) and Type-1 Diabetes. ( 15 ) However, despite its widespread use, there is a gap in validation studies among the adolescent population within the Arab region, and in particular, in Lebanon. Lebanon, a Middle Eastern low-income country, has been grappling with persistent political corruption, social unrest, economic meltdown, and COVID-19 health crisis as well as the devastating Beirut port explosion in 2020. ( 16 ) The recent accelerating depreciation of the local currency has further impoverished the middle class, with approximately 50% of households currently living below the poverty line. ( 17 ) Among the most vulnerable at the center of this reality are Lebanese youth, ( 18 ) who constitute 30% of the overall population ( 19 ). Unfortunately, these adolescents have limited access to mental health support and counseling services, particularly those tailored to the needs of young individuals. A study conducted among Lebanese children and adolescents in the aftermath of the Beirut port explosion revealed alarming rates of probable anxiety among 64% and probable PTSD among 52% of this youth population, which is higher than the numbers reported in other Arab countries. ( 20 ) A recent systematic review to validate screening tools for anxiety disorders and PTSD in Low to Middle Income Countries (LMICs) revealed that the age distribution among screening tools was heavily biased towards the adult population and that children and adolescents accounted for only six of 58 validations for anxiety and depression. ( 21 ) This systematic review emphasized the urgent need for research focused on identifying anxiety and PTSD disorders among pediatric and adolescent populations, especially in regions marred by civil unrest and conflict. Therefore, this study seeks to investigate the validity of the Arabic version of GAD-7, a concise and widely used scale in clinical and research settings, as a screening tool for anxiety symptoms. The primary aim is to analyze the factor structure, reliability and concurrent validity of the Arabic GAD-7 in a sample of Lebanese adolescents. Methods Procedure The study received administrative approval from the Lebanese Ministry of Education and Higher Education (MEHE) and was approved by the Institutional Review Board (LAU IRB; reference number: LAU.SAS.MJ1.28/Oct/2021). In addition to age and gender, participants reported their parents’ job occupations. They then filled standardized scales for anxiety, PTSD, and PTG used in their validated Arabic versions. Participants The sample consisted of 701 high school students aged between 15 and 18, who were recruited from four public schools in Lebanon. Among those participants, 638 students (mean age 16.19 ± 1.02 years) had complete data and were included in the final sample with 56.4% females. A subsample of 359 students was retested at three months, post-initial assessment, to identify additional psychometric properties of the scale. Questionnaires GAD-7 (The Generalized Anxiety Disorder) This is a self-reported questionnaire designed to assess anxiety during the previous two weeks, ( 22 ): It is based on seven items “e.g., Feeling nervous, anxious, or on edge” on a four-point Likert scale ranging from 0 “Not at all” to 3 “Nearly every day”. Higher scores indicate higher severity of symptoms, as scores between 0–4 indicated no anxiety, 5–9 mild, 10–14 moderate, and 15 or more severe anxiety symptoms. It has satisfactory internal consistency (α from .79 – .91;) and has been validated among an Arabic Lebanese population. ( 23 ) PCL-5 (The Post Traumatic Stress Disorder Checklist for DSM-5) This is a self-report measure that evaluates PTSD symptoms after a distressing event ( 24 ): Participants answer four Likert scale questions ranging from 0 “Not at all” to 4 “Extremely”; for example, “In the past month, how much have you been bothered by [event]?” High scores indicate higher PTSD symptoms with a conservative cut-off of 6 for severe symptoms. PCL-5 has been shown to have high internal consistency for the English version (α = .95), and has been validated in Arabic-speaking populations. ( 25 ) PTGI-SF (Posttraumatic Growth Inventory - Short Form) This 10-item scale assesses the experience of positive change resulting from traumatic events ( 26 ): It includes five factors: personal strength, spiritual change, new possibilities in life, appreciation of life, and relating to others. Statements are rated from 0 (“I did not experience this change”) to 5 (“I experienced this change to a great degree”), for example, “I have changed my priorities about what is important in life”. PTGI-SF has shown to have high internal consistency (α = .925) and has been validated in Arabic among Arabic-speaking samples. ( 27 , 28 ) Analytic Strategy Confirmatory factor analysis. There were no missing responses in the dataset. We used data from the total sample to conduct a CFA using the SPSS AMOS v.29 software. We aimed to enroll a minimum of 140 adolescents following the recommendations of Mundfrom and her colleagues of 3 to 20 times the number of the scale’s variables. ( 29 ) Parameter estimates were obtained using the maximum likelihood method. Multiple fit indices were calculated: Steiger-Lind root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), Tucker-Lewis Index (TLI) and Comparative Fit Index (CFI). Values ≤ .08 for RMSEA, ≤ .05 for SRMR, and ≥ .90 for CFI and TLI indicate a good fit of the model to the data. Additionally, values of the average variance extracted (AVE) ≥ .50 indicated evidence of convergent validity. Multivariate normality was not verified at first (Bollen-Stine bootstrap p = .002); therefore, we performed a non-parametric bootstrapping procedure. Gender invariance. To examine the gender invariance of GAD scores, we conducted multi-group CFA using the total sample. Measurement invariance was assessed at the configural, metric, and scalar levels. We accepted ΔCFI ≤ .010 and ΔRMSEA ≤ .015 or ΔSRMR ≤ .010 as evidence of invariance. Further analyses. Composite reliability was assessed using McDonald’s ω and Cronbach’s α, with values greater than .70 reflecting adequate composite reliability. Normality was verified since the skewness and kurtosis values for each item of the scale varied between − 1 and + 1. Pearson test was used to correlate the GAD-7 scores with the other scales in the survey. Student t-test was used to compare two means. Results Descriptive Statistics The mean and standard deviation of the scores were as follows: GAD-7 anxiety (pre: 9.94 ± 5.43, post: 9.82 ± 5.42), PCL-5 PTSD (62.29 ± 7.80) and PTG (29.38 ± 9.53). In the final sample, 19.6% of adolescents had no anxiety, whereas 33.7%, 24.8% and 21.9% of them showed mild, moderate, and severe anxiety respectively. Confirmatory Factor Analysis of the GAD scale CFA indicated that fit of the one-factor model of the GAD scale was acceptable: RMSEA = .085 (90% CI .067, .104), SRMR = .035, CFI = .966, TLI = .949. The standardized estimates of factor loadings were all adequate (Fig. 1 ). Composite reliability of scores was adequate in the total sample (ω = .88 / α = .87). The convergent validity for this model was satisfactory, as AVE = .51. Gender Invariance Results showed invariance across genders at the configural, metric, and scalar levels (Table 1 ). Females showed a higher level of anxiety compared to males (10.96 ± 5.42 vs 7.98 ± 4.94; t (636) = -7.25; p < .001). Interclass correlation The pre-posttest for the GAD-7 scale was done on 359 participants. The intraclass correlation coefficient was adequate = 0.83 [95% CI .79; .86] Table 1 Measurement Invariance of the Generalized Anxiety Disorder 7-item Scale across gender in the total sample. Model CFI RMSEA SRMR Model Comparison ΔCFI ΔRMSEA ΔSRMR Configural .967 .057 .046 Metric .968 .051 .050 Configural vs metric .001 .006 .004 Scalar .956 .055 .053 Metric vs scalar .012 .004 .003 Note. CFI = Comparative fit index; RMSEA = Steiger-Lind root mean square error of approximation; SRMR = Standardised root mean square residual. Concurrent validity Higher PTSD scores ( a = .68; p < .001) correlated with higher GAD-7 scores, whereas higher PTG scores ( r = − .12; p = .004 ) correlated with lower anxiety. Discussion This study aimed to investigate the psychometric properties of a rapid easy-to-use self-administered anxiety scale in Lebanese adolescents. The GAD-7 emerged from this study as a favorable research-friendly and culturally adapted option for assessing anxious symptomatology in the targeted age group between 15 and 18 years. We have investigated factor loading onto a single dimension, along with convergent and divergent validity, test-rest reliability as well as measurement invariance across gender at various levels. Taken together, these properties support the use of GAD-7 in the context of Arabic-speaking adolescents, or adolescents facing similarly challenging socio-economic conditions and unstable political situations. Second, our results indicate alarming levels of anxiety in Lebanese schooled adolescents. In fact, around 80% of participants had detectable symptoms of anxiety, with 47% scoring above moderate to severe cut-offs for probable psychopathology. These excessive rates align with similar findings from a recent study post-Beirut blast equally reporting elevated levels of anxiety (64%) and PTSD (52%). ( 30 ) These results also echo international concerns about the worsening mental health of adolescents and young adults, especially since the onset of the COVID-19 pandemic. ( 31 , 2 ) Anxiety is the leading cause of emotional dysfunctions and mental illness, ( 32 ) impacting one-fifth of young individuals. ( 33 ) This moreover highlights the long-standing mental health burden of piling hardships and calls for public policies and subsequently calls for improved concerted efforts to address the critical needs of underprivileged communities amidst accumulating collective challenges in the country. ( 34 , 35 ) These findings indicate satisfactory psychometric properties of the Arabic version of GAD-7 among Arab-speaking Lebanese adolescents, aligning values and indicators below rigorously acceptable norms. Notably, all 7 items all loaded onto a single factor in our model, similar to the original scale validation, ( 22 ) and other documented validation studies in both adult, ( 36 , 37 ) and adolescent samples. ( 38 , 39 , 40 ) The unidimensional structure indicates the presence of a single homogenous underlying factor triggering the multiplicity of symptomatic expression of anxiety, and encompassing aspects of physiological restlessness, cognitive and emotional hyperactivity, and a sense of uncontrollability. The recent surge of validation studies within the past couple of years indicates the rising interest of the scientific community in detecting and assessing the early onsets of anxiety, as symptoms emerging in childhood and adolescence seem to worsen adult prognosis if left untreated. ( 41 , 42 ) Our results point towards the unidimensional structure of the GAD-7 and support its use to assess anxiety in adolescents in the Middle East and contribute to better monitoring the ongoing global mental health crises. In addition, our study reveals this scale also has measurement invariance across gender at the configural, metric, and scalar levels. While girls in our study scored higher on average than boys on the overall anxiety scale, both girls and boys had equal performances in terms of psychometric properties of the scale items. This is in line with previous literature reviews documenting on one hand the increased levels of anxiety in females as compared to males, ( 38 , 43 ) and on the other, the versatile applicability of GAD-7 scales to both males and females irrespective of the scores and of the manifestation of gender differences of certain symptoms. ( 36 , 37 , 44 ) Additionally, this study demonstrates robust test-retest reliability over two-time points, with more than 50% of the original student pool tested twice, three months apart. This further supports the psychometric robustness of the GAD-7 in young Arabic-speaking school students. Lastly, concurrent validity of the 7-item anxiety scale was further matched against other scales assessing mental distress and wellbeing. The GAD-7 had already been used in adolescents screened positive for depression in primary care and demonstrated strong convergent and discriminant validity. ( 45 ) In this study, the GAD-7 anxiety scores were correlated to responses post-trauma, given the overall socio-political and health situation in the country. The GAD-7 correlated positively with PTSD and negatively with PTG. These findings have been systematically replicated in studies documenting the parallel increase in anxiety and PTSD symptoms after collective traumatic exposure, ( 43 , 46 ) and similarly in situations such as COVID-19 pandemic, political instability, ( 47 ) and economic frailty. ( 48 ) Some studies have pointed to the diminished capacity for growth in people struggling with anxiety, in the absence of additional social support and resilience resources. ( 49 , 50 ) Clinical Implications This study provides evidence of the efficacy of the GAD-7 scale in assessing anxiety symptoms among Arabic-speaking adolescents in public schools in Lebanon. The user-friendly nature of this scale, as well as its cultural sensitivity and appropriateness for ages 15–18, renders it a valuable tool for educators and clinicians seeking to swiftly assess psychopathological dysfunction. This is particularly important as a screening tool to fine-tune early detection of anxiety in this vulnerable age group and potentially implement protective interventions among high-school students to help them better navigate upcoming developmental and environmental challenges. Our findings also point to the usefulness of using this scale for longitudinal assessment of prevalence rates of anxiety over time. This is particularly important as anxiety in adolescents is associated with impaired functioning, diminished academic performance, heightened dropout rates, as well as lower wellbeing and poorer quality of life. ( 9 ) Limitations and Recommendations for Future Research This study supports the use of the GAD-7 Arabic version in young adolescents in a Middle Eastern country. However, additional studies are needed to properly generalize these findings to other Arabic-speaking adolescents from diverse socio-educational backgrounds, including those who are not enrolled in schools. Targeting clinical populations with diagnosable mental distress or physical conditions would further enrich our understanding of the scale’s efficacy. Relying solely on self-report measures could introduce biases such as social desirability, memory inaccuracies, or potential misinterpretations of items, and validation studies using only typical-performance tests are at risk of mono-method biases; thus, future studies could benefit from incorporating objective measures of anxiety (such as neurophysiological testing). In addition, it would be beneficial to continue monitoring the applicability of the scale in relation to other demographic factors, such as nuanced Arabic dialects or ways of life in urban v/s rural settings. Finally, due to the study focus on school adolescents, the findings should be generalizable with caution due to potential selection bias. Conclusion The Arabic GAD-7 shows solid psychometric properties in a sample of Lebanese adolescents, further evidencing the valid use of this fast, publicly available, assessment tool to measure levels of anxiety. In this line, current initiatives have shown preliminary efficacy in decreasing psychological distress and fostering wellbeing through an emotional intelligence training program targeting youth in public schools in Lebanon. ( 51 ) With potential benefits for education and research settings targeting Arabic-speaking educated youth, GAD-7 could contribute to routine evidence-based developmentally tailored measurements. By integrating the GAD-7 into routine evaluations, stakeholders in both institutional and governmental spheres can gain insights into the emotional and mental wellbeing of school-aged students, thus facilitating informed decision-making and targeted psychological interventions. Declarations Human Ethics approval and Consent to participate declaration. In accordance with the Declaration of Helsinki, all participants and their parents approved and signed the informed consent. The consent was given by the Institutional Review Board LAU.SAS.MJ1.28/Oct/2021. Consent for publication . Not applicable Availability of data and materials. The datasets used and/or analyzes during the current study are available from the corresponding author on reasonable request. Competing interests. The authors declare that they have no competing interests Funding. This research was funded by Grand Challenges Canada – Global Mental Health – NIHS; R-GMH-POC-2107-47498. M.J. Sanchez-Ruiz’s work was supported by Ramón y Cajal program (RYC2020-030471-I) funded by the Spanish Ministry of Science and Innovation (MCIN/AEI/10.13039/501100011039) and FSE (Invierte en tu futuro). Authors' contributions . M.SR, R.D, M.EK designed the study. R.D, M.EK wrote the main manuscript and S.H prepared the analyses and corresponding tables. All authors reviewed the manuscript. Acknowledgements . The authors wish to acknowledge all those who made the YEY project possible. References World Health Organization. Depression and other common mental disorders: Global health estimate. 2017. Retrieved from https://iris.who.int/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf . World Health Organization. Adolescent mental health. 2021. Retrieved from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Some%20adolescents%20are%20at%20greater . Burstein M, Beesdo-Baum K, He JP, Merikangas KR. Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics. Psychol Med. 2014;44(11):2351–62. Herr NR, Williams JW, Benjamin S, McDuffie J. Does this patient have generalized anxiety or panic disorder? The Rational Clinical Examination systematic review. JAMA. 2014;312(1):78–84. The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry. 2002;41(9):1061-9. 10.1097/00004583-200209000-00006 . PMID: 12218427. Spielberger CD, Gorsuch RL. State-trait anxiety inventory for adults: Sampler set: Manual, Tekst booklet and scoring key. Consulting Psychologists; 1983. Reynolds CR, Richmond BO. What I think and feel: A revised measure of children's manifest anxiety. J Abnorm Child Psychol. 1978;6:271–80. Mossman SA, Luft MJ, Schroeder HK, Varney ST, Fleck DE, Barzman DH, Gilman R, DelBello MP, Strawn JR. The Generalized Anxiety Disorder 7-item (GAD-7) scale in adolescents with generalized anxiety disorder: signal detection and validation. Annals Clin psychiatry: official J Am Acad Clin Psychiatrists. 2017;29(4):227. Casares MÁ, Díez-Gómez A, Pérez-Albéniz A, Lucas-Molina B, Fonseca-Pedrero E. Screening for anxiety in adolescents: Validation of the Generalized Anxiety Disorder Assessment-7 in a representative sample of adolescents. J Affect Disord. 2024 Mar 14. Ip H, Suen YN, Hui CL, Wong SM, Chan SK, Lee EH, Wong MT, Chen EY. Assessing anxiety among adolescents in Hong Kong: psychometric properties and validity of the Generalised Anxiety Disorder-7 (GAD-7) in an epidemiological community sample. BMC Psychiatry. 2022;22(1):703. Sun J, Liang K, Chi X, Chen S. Psychometric properties of the generalized anxiety disorder scale-7 item (GAD-7) in a large sample of Chinese adolescents. InHealthcare 2021 Dec 9 (Vol. 9, No. 12, p. 1709). MDPI. Marlow M, Skeen S, Grieve CM, Carvajal-Velez L, Åhs JW, Kohrt BA, Requejo J, Stewart J, Henry J, Goldstone D, Kara T. Detecting depression and anxiety among adolescents in South Africa: validity of the isiXhosa patient health Questionnaire-9 and generalized anxiety Disorder-7. J Adolesc Health. 2023;72(1):S52–60. Adjorlolo S. Generalised anxiety disorder in adolescents in Ghana: Examination of the psychometric properties of the Generalised Anxiety Disorder-7 scale. Afr J Psychol Assess. 2019;1(1). Gibler RC, Marzouk MA, Peugh J, Reidy BL, Ernst MM, Daffin ML, Powers SW, Kabbouche Samaha M, Kacperski J, Hershey AD, O'Brien H. Clinic-Based Characterization of Adolescents and Young Adults With Migraine: Psychological Functioning, Headache Days, and Disability. Neurology: Clinical Practice. 2024;14(3):e200294. Stahl-Pehe A, Selinski S, Bächle C, Castillo K, Lange K, Holl RW, Rosenbauer J. Screening for generalized anxiety disorder (GAD) and associated factors in adolescents and young adults with type 1 diabetes: Cross-sectional results of a Germany-wide population-based study. Diabetes Res Clin Pract. 2022;184:109197. El Hajj S. Writing (from) the Rubble: reflections on the August 4, 2020 explosion in Beirut, Lebanon. InEssays in Life Writing 2021 Nov 29 (pp. 7–23). Routledge. World Health Organization. Basic documents. 49th ed. Geneva: The Organization; 2020. https://www.who.int/health-topics/adolescent-health#tab=tab_1 . El Hajj S. Theorising Lebano-Pathography: A Biographical Exploration of Medical-Cultural Pathologies. Life Writ. 2023;20(4):643–56. UNDP. Lebanon's youth: Barriers for growth and unfolding opportunities. 2022. Retrieved from: https://www.undp.org/lebanon/blog/lebanons-youth-barriers-growth-and-unfolding-opportunities . Al-Yateem N, Bani issa W, Rossiter RC, Al-Shujairi A, Radwan H, Awad M, Fakhry R, Mahmoud I. Anxiety related disorders in adolescents in the United Arab Emirates: a population based cross-sectional study. BMC Pediatr. 2020;20:1–8. Mughal AY, Devadas J, Ardman E, Levis B, Go VF, Gaynes BN. A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries. BMC Psychiatry. 2020;20:1–8. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire–9 (PHQ-9) and the Generalized Anxiety Disorder–7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245–52. Zuromski KL, Ustun B, Hwang I, Keane TM, Marx BP, Stein MB, Ursano RJ, Kessler RC. Developing an optimal short-form of the PTSD Checklist for DSM‐5 (PCL‐5). Depress Anxiety. 2019;36(9):790–800. Brahim CB, El Kefi H, Awissawi A, Kabtni W, Baatout A, Bouizouita I, Bouguerra C, Eddif S, Oumaya A. Validation in literary Arabic among Tunisian soldiers of the Post-Traumatic Stress Disorder checklist for DSM-5. Pan Afr Med J. 2022;43:28. Leong Abdullah MF, Nik Jaafar NR, Zakaria H, Rajandram RK, Mahadevan R, Mohamad Yunus MR, Shah SA. Posttraumatic growth, depression and anxiety in head and neck cancer patients: examining their patterns and correlations in a prospective study. Psycho-oncology. 2015;24(8):894–900. Fekih-Romdhane F, Fawaz M, Hallit R, Sawma T, Obeid S, Hallit S. Psychometric Properties of an Arabic translation of the 10-item Connor-Davidson Resilience scale (CD-RISC-10), the 8-and 10-item post-traumatic growth inventory-short form (PTGI-SF) scales. PLoS ONE. 2024;19(1):e0293079. Veronese G, Pepe A. Using the posttraumatic growth inventory–short form with Palestinian helpers living in conflict areas. Meas Evaluation Couns Dev. 2019;52(3):207–21. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. Int J Test. 2005;5(2):159–68. Maalouf FT, Haidar R, Mansour F, Elbejjani M, El Khoury J, Khoury B, Ghandour LA. Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion. J Affect Disord. 2022;302:58–65. Marquez J, Taylor L, Boyle L, Zhou W, De Neve JE. Child and adolescent well-being: Global trends, challenges and opportunities. 2024 Retrieved from: https://worldhappiness.report/ed/2024/child-and-adolescent-well-being-global-trends-challenges-and-opportunities/ . Yang X, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang L, Lu M. Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiol psychiatric Sci. 2021;30:e36. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897–910. El Khoury-Malhame M, Rizk R, Joukayem E, Rechdan A, Sawma T. The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults. BMC Psychol. 2023;11(1):14. Khoury-Malhame E, Bou Malhab S, Chaaya R, Sfeir M, El Khoury S. Coping during socio-political uncertainty. Front Psychiatry. 2024;14:1267603. Byrd-Bredbenner C, Eck K, Quick V. GAD-7, GAD-2, and GAD-mini: psychometric properties and norms of university students in the United States. Gen Hosp Psychiatry. 2021;69:61–6. Hinz A, Klein AM, Brähler E, Glaesmer H, Luck T, Riedel-Heller SG, Wirkner K, Hilbert A. Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample. J Affect Disord. 2017;210:338–44. Marcynyszyn LA, McCarty CA, Chrisman SP, Zatzick DF, Johnson AM, Wang J, Hilt RJ, Rivara FP. Psychometric properties and validation of the general anxiety disorder 7-item scale among adolescents with persistent post-concussive symptoms. Neurotrauma Rep. 2023;4(1):276–83. Crockett MA, Martinez V, Ordonez-Carrasco JL. Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents. Rev Med Chil. 2022;150(4):458–64. Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Res. 2019;272:30–5. Heiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud MB, Ullebø AK, Plessen KJ, Bjelland I, Lie SA, Gillberg C. Psychiatric disorders in Norwegian 8-to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry. 2007;46(4):438–47. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281–95. Niwenahisemo LC, Hong S, Kuang L. Assessing anxiety symptom severity in Rwandese adolescents: cross-gender measurement invariance of GAD-7. Front Psychiatry. 2024;15:1346267. Guzick A, Storch EA, Smárason O, Minhajuddin A, Drummond K, Riddle D, Hettema JM, Mayes TL, Pitts S, Dodd C, Trivedi MH. Psychometric properties of the GAD-7 and PROMIS-Anxiety-4a among youth with depression and suicidality: Results from the Texas youth depression and suicide research network. J Psychiatr Res. 2024;170:237–44. Hughes JL, Grannemann BD, Trombello JM, Martin WB, Fuller AK, Trivedi MH. Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample. Annals Clin Psychiatry: Official J Am Acad Clin Psychiatrists. 2021;33(4):241–50. Neugebauer R, Turner JB, Fisher PW, Yamabe S, Zhang B, Neria Y, Gameroff M, Bolton P, Mack R. Posttraumatic stress reactions among Rwandan youth in the second year after the genocide: Rising trajectory among girls. Psychol Trauma: Theory Res Pract Policy. 2014;6(3):269. Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rincón-Rodríguez CJ, González-Ballesteros LM, Bird V, Priebe S, van Loggerenberg F. Mental health problems and resilience in adolescents during the COVID-19 pandemic in a post-armed conflict area in Colombia. Sci Rep. 2023;13(1):9743. Bou-Hamad I, Hoteit R, Harajli D, Reykowska D. Personal economic worries in response to COVID-19 pandemic: a cross sectional study. Front Psychol. 2022;13:871209. https://doi.org/10.3389/fpsyg.2022.871209 . El Khoury-Malhame M, Sfeir M, Hallit S, Sawma T. Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon. Curr Psychol. 2024;43(13):12061–70. Hu J, Huang Y, Liu J, Zheng Z, Xu X, Zhou Y, Wang J. COVID-19 related stress and mental health outcomes 1 year after the peak of the pandemic outbreak in china: the mediating effect of resilience and social support. Front Psychiatry. 2022;13:828379. Sanchez-Ruiz MJ, El Khoury M, Doumit R, Nassar E, Wanna P, AlHassanieh M, Chaaya R, Zgheib P, Tadros N, Khalaf T, Petrides KV. Increasing emotional intelligence through Yes to Emotions in Youth (YEY): Evidence from its implementation in Lebanese public schools. Journal of Personality and Individual Differences. 2023. In Press. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4486990","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309085052,"identity":"7ba634f4-d74a-4bf3-beca-ec3c81c67095","order_by":0,"name":"Myriam El Khoury-Malhame","email":"","orcid":"","institution":"Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Lebanon","correspondingAuthor":false,"prefix":"","firstName":"Myriam","middleName":"El","lastName":"Khoury-Malhame","suffix":""},{"id":309085053,"identity":"b638a51a-e55e-45da-96ce-f56433e48788","order_by":1,"name":"Souheil Hallit","email":"","orcid":"","institution":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon","correspondingAuthor":false,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""},{"id":309085057,"identity":"032f9442-61b4-48ee-8a32-91ab6db800a1","order_by":2,"name":"Maria-Jose Sanchez-Ruiz","email":"","orcid":"","institution":"Developmental Psychology Unit, Faculty of Education, Universidad de Alcalá de Henares","correspondingAuthor":false,"prefix":"","firstName":"Maria-Jose","middleName":"","lastName":"Sanchez-Ruiz","suffix":""},{"id":309085063,"identity":"490bb704-ccac-46ac-bbae-7c1ae6bee920","order_by":3,"name":"Sleiman El Hajj","email":"","orcid":"","institution":"Department of Communication, Arts and Languages, School of Arts and Sciences, Lebanese American University, Lebanon","correspondingAuthor":false,"prefix":"","firstName":"Sleiman","middleName":"El","lastName":"Hajj","suffix":""},{"id":309085067,"identity":"7f328982-b7f2-4a85-8ab0-babcfe69b8ed","order_by":4,"name":"Rita Doumit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACZhDBBmYwPngAFkpgYHjYgE8LM0wLM7NBAkxLIj4tDDAtDMxsEkRpMW/nP/iBocwmcW07/7GKhJrDDPzsOQYMiTtwa5E5zMwswXAuLXHbYWa2GwnHDjNI9rwBajmDW4sE0C8SjG2HoVrYDjMY3ADZ0oZXC/MPmJaChH+HGeyJ0MIGtwWoEmiLBGEtZhYJ59KMgVqMJRL70nkkzjwrOIDXL/wHH9/4UGYju+38wYcfPnyzluNvT9744COeEAODBCQ2D4g4QEDDKBgFo2AUjAICAABaSUx3qJ2cBAAAAABJRU5ErkJggg==","orcid":"","institution":"Alice Ramez Chaghoury School of Nursing, Lebanese American University","correspondingAuthor":true,"prefix":"","firstName":"Rita","middleName":"","lastName":"Doumit","suffix":""}],"badges":[],"createdAt":"2024-05-27 20:55:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4486990/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4486990/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58384845,"identity":"9e9486aa-6d1f-42a8-816d-60a7ae116d78","added_by":"auto","created_at":"2024-06-14 18:37:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62585,"visible":true,"origin":"","legend":"\u003cp\u003eStandardized loading factors of the Generalized Anxiety Disorder 7-item Scale in Arabic.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4486990/v1/fd892d6acf165175e0ca8f9e.png"},{"id":63273075,"identity":"97e65dfe-d68f-48b6-ac9a-e827082d985b","added_by":"auto","created_at":"2024-08-26 11:37:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549032,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4486990/v1/bee6f979-1b58-499a-a9dc-1f0fecee67ba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric validation of the Arabic version of the GAD-7 among Lebanese Adolescents","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnxiety disorders represent a prevalent mental health challenge globally, affecting people of all ages and backgrounds. In particular, during adolescence and young adult years, adolescents are prone to mental health problems. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Anxiety disorders can significantly impair an individual's ability to function in daily life, impacting relationships, academic performance, and overall wellbeing. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) According to the World Health Organization, Generalized Anxiety Disorder (GAD) is a mental health condition characterized by excessive and persistent worry or anxiety about various aspects of life, such as work, relationships, health, or everyday situations. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The DSM-5 defines general anxiety disorder as an excessive worry about particular events or performance occurring on most days than not, for more than six months. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The worry is difficult to control and is often accompanied by symptoms such as restlessness, irritability, muscle tension, difficulty concentrating, and sleep disturbances. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite the significant impact of anxiety disorders on the adolescent population, these are often under-diagnosed and untreated. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Recently, it has been suggested that care might be improved if clinicians used standardized questionnaires to identify patients with previously unrecognized anxiety disorders. A systematic review of screening tools conducted by Herr and her colleagues (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) revealed that the GAD-7 had the best performance characteristics for identifying anxiety disorders in comparison to other measures.\u003c/p\u003e \u003cp\u003eThe GAD-7 stands out for its brevity and practical utility, with only 7 items as opposed to the Pediatric Anxiety Rating scale (50 items), (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), the State-Trait Anxiety Inventory for Children (20 items), (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and the Revised Children\u0026rsquo;s Manifest Anxiety Scale (49 items). (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) GAD- 7 has strong psychometric properties, minimal overlap with scales measuring mental distress and might be completed by an adolescent in less than two minutes. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) In addition, GAD-7 can be employed as a standardized cross-cultural measurement tool as it has been used in the adolescent population in many countries such as Spain, (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Hong Kong, (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) China, (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) South Africa, (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and Ghana, (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) among others. The GAD-7 has even been used in the clinical adolescent population with migraine, (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and Type-1 Diabetes. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) However, despite its widespread use, there is a gap in validation studies among the adolescent population within the Arab region, and in particular, in Lebanon.\u003c/p\u003e \u003cp\u003eLebanon, a Middle Eastern low-income country, has been grappling with persistent political corruption, social unrest, economic meltdown, and COVID-19 health crisis as well as the devastating Beirut port explosion in 2020. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) The recent accelerating depreciation of the local currency has further impoverished the middle class, with approximately 50% of households currently living below the poverty line. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Among the most vulnerable at the center of this reality are Lebanese youth, (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) who constitute 30% of the overall population (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Unfortunately, these adolescents have limited access to mental health support and counseling services, particularly those tailored to the needs of young individuals. A study conducted among Lebanese children and adolescents in the aftermath of the Beirut port explosion revealed alarming rates of probable anxiety among 64% and probable PTSD among 52% of this youth population, which is higher than the numbers reported in other Arab countries. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) A recent systematic review to validate screening tools for anxiety disorders and PTSD in Low to Middle Income Countries (LMICs) revealed that the age distribution among screening tools was heavily biased towards the adult population and that children and adolescents accounted for only six of 58 validations for anxiety and depression. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) This systematic review emphasized the urgent need for research focused on identifying anxiety and PTSD disorders among pediatric and adolescent populations, especially in regions marred by civil unrest and conflict.\u003c/p\u003e \u003cp\u003eTherefore, this study seeks to investigate the validity of the Arabic version of GAD-7, a concise and widely used scale in clinical and research settings, as a screening tool for anxiety symptoms. The primary aim is to analyze the factor structure, reliability and concurrent validity of the Arabic GAD-7 in a sample of Lebanese adolescents.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003e The study received administrative approval from the Lebanese Ministry of Education and Higher Education (MEHE) and was approved by the Institutional Review Board (LAU IRB; reference number: LAU.SAS.MJ1.28/Oct/2021). In addition to age and gender, participants reported their parents\u0026rsquo; job occupations. They then filled standardized scales for anxiety, PTSD, and PTG used in their validated Arabic versions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe sample consisted of 701 high school students aged between 15 and 18, who were recruited from four public schools in Lebanon. Among those participants, 638 students (mean age 16.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 years) had complete data and were included in the final sample with 56.4% females. A subsample of 359 students was retested at three months, post-initial assessment, to identify additional psychometric properties of the scale.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eQuestionnaires\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section4\"\u003e \u003ch2\u003eGAD-7 (The Generalized Anxiety Disorder)\u003c/h2\u003e \u003cp\u003eThis is a self-reported questionnaire designed to assess anxiety during the previous two weeks, (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e): It is based on seven items \u0026ldquo;e.g., Feeling nervous, anxious, or on edge\u0026rdquo; on a four-point Likert scale ranging from 0 \u0026ldquo;Not at all\u0026rdquo; to 3 \u0026ldquo;Nearly every day\u0026rdquo;. Higher scores indicate higher severity of symptoms, as scores between 0\u0026ndash;4 indicated no anxiety, 5\u0026ndash;9 mild, 10\u0026ndash;14 moderate, and 15 or more severe anxiety symptoms. It has satisfactory internal consistency (α from .79 \u0026ndash; .91;) and has been validated among an Arabic Lebanese population. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003ePCL-5 (The Post Traumatic Stress Disorder Checklist for DSM-5)\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThis is a self-report measure that evaluates PTSD symptoms after a distressing event (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e): Participants answer four Likert scale questions ranging from 0 \u0026ldquo;Not at all\u0026rdquo; to 4 \u0026ldquo;Extremely\u0026rdquo;; for example, \u0026ldquo;In the past month, how much have you been bothered by [event]?\u0026rdquo; High scores indicate higher PTSD symptoms with a conservative cut-off of 6 for severe symptoms. PCL-5 has been shown to have high internal consistency for the English version (α\u0026thinsp;=\u0026thinsp;.95), and has been validated in Arabic-speaking populations. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003ePTGI-SF (Posttraumatic Growth Inventory - Short Form)\u003c/h2\u003e \u003cp\u003eThis 10-item scale assesses the experience of positive change resulting from traumatic events (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e): It includes five factors: personal strength, spiritual change, new possibilities in life, appreciation of life, and relating to others. Statements are rated from 0 (\u0026ldquo;I did not experience this change\u0026rdquo;) to 5 (\u0026ldquo;I experienced this change to a great degree\u0026rdquo;), for example, \u0026ldquo;I have changed my priorities about what is important in life\u0026rdquo;. PTGI-SF has shown to have high internal consistency (α\u0026thinsp;=\u0026thinsp;.925) and has been validated in Arabic among Arabic-speaking samples. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eAnalytic Strategy\u003c/h2\u003e \u003cp\u003e \u003cb\u003eConfirmatory factor analysis.\u003c/b\u003e There were no missing responses in the dataset. We used data from the total sample to conduct a CFA using the SPSS AMOS v.29 software. We aimed to enroll a minimum of 140 adolescents following the recommendations of Mundfrom and her colleagues of 3 to 20 times the number of the scale\u0026rsquo;s variables. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Parameter estimates were obtained using the maximum likelihood method. Multiple fit indices were calculated: Steiger-Lind root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), Tucker-Lewis Index (TLI) and Comparative Fit Index (CFI). Values\u0026thinsp;\u0026le;\u0026thinsp;.08 for RMSEA, \u0026le; .05 for SRMR, and \u0026ge;\u0026thinsp;.90 for CFI and TLI indicate a good fit of the model to the data. Additionally, values of the average variance extracted (AVE)\u0026thinsp;\u0026ge;\u0026thinsp;.50 indicated evidence of convergent validity. Multivariate normality was not verified at first (Bollen-Stine bootstrap p\u0026thinsp;=\u0026thinsp;.002); therefore, we performed a non-parametric bootstrapping procedure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGender invariance.\u003c/b\u003e To examine the gender invariance of GAD scores, we conducted multi-group CFA using the total sample. Measurement invariance was assessed at the configural, metric, and scalar levels. We accepted ΔCFI\u0026thinsp;\u0026le;\u0026thinsp;.010 and ΔRMSEA\u0026thinsp;\u0026le;\u0026thinsp;.015 or ΔSRMR\u0026thinsp;\u0026le;\u0026thinsp;.010 as evidence of invariance.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFurther analyses.\u003c/b\u003e Composite reliability was assessed using McDonald\u0026rsquo;s ω and Cronbach\u0026rsquo;s α, with values greater than .70 reflecting adequate composite reliability. Normality was verified since the skewness and kurtosis values for each item of the scale varied between \u0026minus;\u0026thinsp;1 and +\u0026thinsp;1. Pearson test was used to correlate the GAD-7 scores with the other scales in the survey. Student t-test was used to compare two means.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Statistics\u003c/h2\u003e \u003cp\u003eThe mean and standard deviation of the scores were as follows: GAD-7 anxiety (pre: 9.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43, post: 9.82\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42), PCL-5 PTSD (62.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.80) and PTG (29.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53). In the final sample, 19.6% of adolescents had no anxiety, whereas 33.7%, 24.8% and 21.9% of them showed mild, moderate, and severe anxiety respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis of the GAD scale\u003c/h2\u003e \u003cp\u003eCFA indicated that fit of the one-factor model of the GAD scale was acceptable: RMSEA\u0026thinsp;=\u0026thinsp;.085 (90% CI .067, .104), SRMR\u0026thinsp;=\u0026thinsp;.035, CFI\u0026thinsp;=\u0026thinsp;.966, TLI\u0026thinsp;=\u0026thinsp;.949. The standardized estimates of factor loadings were all adequate (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Composite reliability of scores was adequate in the total sample (ω\u0026thinsp;=\u0026thinsp;.88 / α\u0026thinsp;=\u0026thinsp;.87). The convergent validity for this model was satisfactory, as AVE\u0026thinsp;=\u0026thinsp;.51.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eGender Invariance\u003c/h2\u003e \u003cp\u003eResults showed invariance across genders at the configural, metric, and scalar levels (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Females showed a higher level of anxiety compared to males (10.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42 vs 7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94; \u003cem\u003et\u003c/em\u003e(636) = -7.25; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInterclass correlation\u003c/h2\u003e \u003cp\u003eThe pre-posttest for the GAD-7 scale was done on 359 participants. The intraclass correlation coefficient was adequate\u0026thinsp;=\u0026thinsp;0.83 [95% CI .79; .86]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeasurement Invariance of the Generalized Anxiety Disorder 7-item Scale across gender in the total sample.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel Comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΔCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eΔRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eΔSRMR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfigural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConfigural vs metric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScalar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMetric vs scalar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eNote.\u003c/em\u003e CFI\u0026thinsp;=\u0026thinsp;Comparative fit index; RMSEA\u0026thinsp;=\u0026thinsp;Steiger-Lind root mean square error of approximation; SRMR\u0026thinsp;=\u0026thinsp;Standardised root mean square residual.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConcurrent validity\u003c/h2\u003e \u003cp\u003eHigher PTSD scores (\u003cem\u003ea\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.68; p\u0026thinsp;\u0026lt;\u0026thinsp;.001) correlated with higher GAD-7 scores, whereas higher PTG scores (\u003cem\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.12; p\u0026thinsp;=\u0026thinsp;.004\u003c/em\u003e) correlated with lower anxiety.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the psychometric properties of a rapid easy-to-use self-administered anxiety scale in Lebanese adolescents. The GAD-7 emerged from this study as a favorable research-friendly and culturally adapted option for assessing anxious symptomatology in the targeted age group between 15 and 18 years. We have investigated factor loading onto a single dimension, along with convergent and divergent validity, test-rest reliability as well as measurement invariance across gender at various levels. Taken together, these properties support the use of GAD-7 in the context of Arabic-speaking adolescents, or adolescents facing similarly challenging socio-economic conditions and unstable political situations.\u003c/p\u003e \u003cp\u003eSecond, our results indicate alarming levels of anxiety in Lebanese schooled adolescents. In fact, around 80% of participants had detectable symptoms of anxiety, with 47% scoring above moderate to severe cut-offs for probable psychopathology. These excessive rates align with similar findings from a recent study post-Beirut blast equally reporting elevated levels of anxiety (64%) and PTSD (52%). (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) These results also echo international concerns about the worsening mental health of adolescents and young adults, especially since the onset of the COVID-19 pandemic. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Anxiety is the leading cause of emotional dysfunctions and mental illness, (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) impacting one-fifth of young individuals. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) This moreover highlights the long-standing mental health burden of piling hardships and calls for public policies and subsequently calls for improved concerted efforts to address the critical needs of underprivileged communities amidst accumulating collective challenges in the country. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThese findings indicate satisfactory psychometric properties of the Arabic version of GAD-7 among Arab-speaking Lebanese adolescents, aligning values and indicators below rigorously acceptable norms. Notably, all 7 items all loaded onto a single factor in our model, similar to the original scale validation, (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and other documented validation studies in both adult, (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and adolescent samples. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) The unidimensional structure indicates the presence of a single homogenous underlying factor triggering the multiplicity of symptomatic expression of anxiety, and encompassing aspects of physiological restlessness, cognitive and emotional hyperactivity, and a sense of uncontrollability. The recent surge of validation studies within the past couple of years indicates the rising interest of the scientific community in detecting and assessing the early onsets of anxiety, as symptoms emerging in childhood and adolescence seem to worsen adult prognosis if left untreated. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) Our results point towards the unidimensional structure of the GAD-7 and support its use to assess anxiety in adolescents in the Middle East and contribute to better monitoring the ongoing global mental health crises.\u003c/p\u003e \u003cp\u003eIn addition, our study reveals this scale also has measurement invariance across gender at the configural, metric, and scalar levels. While girls in our study scored higher on average than boys on the overall anxiety scale, both girls and boys had equal performances in terms of psychometric properties of the scale items. This is in line with previous literature reviews documenting on one hand the increased levels of anxiety in females as compared to males, (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and on the other, the versatile applicability of GAD-7 scales to both males and females irrespective of the scores and of the manifestation of gender differences of certain symptoms. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) Additionally, this study demonstrates robust test-retest reliability over two-time points, with more than 50% of the original student pool tested twice, three months apart. This further supports the psychometric robustness of the GAD-7 in young Arabic-speaking school students.\u003c/p\u003e \u003cp\u003eLastly, concurrent validity of the 7-item anxiety scale was further matched against other scales assessing mental distress and wellbeing. The GAD-7 had already been used in adolescents screened positive for depression in primary care and demonstrated strong convergent and discriminant validity. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) In this study, the GAD-7 anxiety scores were correlated to responses post-trauma, given the overall socio-political and health situation in the country. The GAD-7 correlated positively with PTSD and negatively with PTG. These findings have been systematically replicated in studies documenting the parallel increase in anxiety and PTSD symptoms after collective traumatic exposure, (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and similarly in situations such as COVID-19 pandemic, political instability, (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) and economic frailty. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) Some studies have pointed to the diminished capacity for growth in people struggling with anxiety, in the absence of additional social support and resilience resources. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThis study provides evidence of the efficacy of the GAD-7 scale in assessing anxiety symptoms among Arabic-speaking adolescents in public schools in Lebanon. The user-friendly nature of this scale, as well as its cultural sensitivity and appropriateness for ages 15\u0026ndash;18, renders it a valuable tool for educators and clinicians seeking to swiftly assess psychopathological dysfunction. This is particularly important as a screening tool to fine-tune early detection of anxiety in this vulnerable age group and potentially implement protective interventions among high-school students to help them better navigate upcoming developmental and environmental challenges.\u003c/p\u003e \u003cp\u003eOur findings also point to the usefulness of using this scale for longitudinal assessment of prevalence rates of anxiety over time. This is particularly important as anxiety in adolescents is associated with impaired functioning, diminished academic performance, heightened dropout rates, as well as lower wellbeing and poorer quality of life. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Recommendations for Future Research\u003c/h2\u003e \u003cp\u003eThis study supports the use of the GAD-7 Arabic version in young adolescents in a Middle Eastern country. However, additional studies are needed to properly generalize these findings to other Arabic-speaking adolescents from diverse socio-educational backgrounds, including those who are not enrolled in schools. Targeting clinical populations with diagnosable mental distress or physical conditions would further enrich our understanding of the scale\u0026rsquo;s efficacy. Relying solely on self-report measures could introduce biases such as social desirability, memory inaccuracies, or potential misinterpretations of items, and validation studies using only typical-performance tests are at risk of mono-method biases; thus, future studies could benefit from incorporating objective measures of anxiety (such as neurophysiological testing). In addition, it would be beneficial to continue monitoring the applicability of the scale in relation to other demographic factors, such as nuanced Arabic dialects or ways of life in urban v/s rural settings.\u003c/p\u003e \u003cp\u003eFinally, due to the study focus on school adolescents, the findings should be generalizable with caution due to potential selection bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Arabic GAD-7 shows solid psychometric properties in a sample of Lebanese adolescents, further evidencing the valid use of this fast, publicly available, assessment tool to measure levels of anxiety. In this line, current initiatives have shown preliminary efficacy in decreasing psychological distress and fostering wellbeing through an emotional intelligence training program targeting youth in public schools in Lebanon. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) With potential benefits for education and research settings targeting Arabic-speaking educated youth, GAD-7 could contribute to routine evidence-based developmentally tailored measurements. By integrating the GAD-7 into routine evaluations, stakeholders in both institutional and governmental spheres can gain insights into the emotional and mental wellbeing of school-aged students, thus facilitating informed decision-making and targeted psychological interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics approval and Consent to participate declaration.\u003c/strong\u003e In accordance with the Declaration of Helsinki, all participants and their parents approved and signed the informed consent. The consent was given by the Institutional Review Board\u0026nbsp;LAU.SAS.MJ1.28/Oct/2021.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e. Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u003c/strong\u003e The datasets used and/or analyzes during the current study are available from the corresponding author on reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e This research was funded by Grand Challenges Canada \u0026ndash; Global Mental Health \u0026ndash; NIHS; R-GMH-POC-2107-47498.\u003c/p\u003e\n\u003cp\u003eM.J. Sanchez-Ruiz\u0026rsquo;s work was supported by Ram\u0026oacute;n y Cajal program (RYC2020-030471-I) funded by the Spanish Ministry of Science and Innovation (MCIN/AEI/10.13039/501100011039) and FSE (Invierte en tu futuro).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e. M.SR, R.D, M.EK designed the study. R.D, M.EK wrote the main manuscript and S.H prepared the analyses and corresponding tables. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e. The authors wish to acknowledge all those who made the YEY project possible.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Depression and other common mental disorders: Global health estimate. 2017. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Adolescent mental health. 2021. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Some%20adolescents%20are%20at%20greater\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Some%20adolescents%20are%20at%20greater\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurstein M, Beesdo-Baum K, He JP, Merikangas KR. Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics. Psychol Med. 2014;44(11):2351\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerr NR, Williams JW, Benjamin S, McDuffie J. Does this patient have generalized anxiety or panic disorder? The Rational Clinical Examination systematic review. JAMA. 2014;312(1):78\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. J Am Acad Child Adolesc Psychiatry. 2002;41(9):1061-9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00004583-200209000-00006\u003c/span\u003e\u003cspan address=\"10.1097/00004583-200209000-00006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 12218427.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpielberger CD, Gorsuch RL. State-trait anxiety inventory for adults: Sampler set: Manual, Tekst booklet and scoring key. Consulting Psychologists; 1983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReynolds CR, Richmond BO. What I think and feel: A revised measure of children's manifest anxiety. J Abnorm Child Psychol. 1978;6:271\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMossman SA, Luft MJ, Schroeder HK, Varney ST, Fleck DE, Barzman DH, Gilman R, DelBello MP, Strawn JR. The Generalized Anxiety Disorder 7-item (GAD-7) scale in adolescents with generalized anxiety disorder: signal detection and validation. Annals Clin psychiatry: official J Am Acad Clin Psychiatrists. 2017;29(4):227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasares M\u0026Aacute;, D\u0026iacute;ez-G\u0026oacute;mez A, P\u0026eacute;rez-Alb\u0026eacute;niz A, Lucas-Molina B, Fonseca-Pedrero E. Screening for anxiety in adolescents: Validation of the Generalized Anxiety Disorder Assessment-7 in a representative sample of adolescents. J Affect Disord. 2024 Mar 14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIp H, Suen YN, Hui CL, Wong SM, Chan SK, Lee EH, Wong MT, Chen EY. Assessing anxiety among adolescents in Hong Kong: psychometric properties and validity of the Generalised Anxiety Disorder-7 (GAD-7) in an epidemiological community sample. BMC Psychiatry. 2022;22(1):703.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun J, Liang K, Chi X, Chen S. Psychometric properties of the generalized anxiety disorder scale-7 item (GAD-7) in a large sample of Chinese adolescents. InHealthcare 2021 Dec 9 (Vol. 9, No. 12, p. 1709). MDPI.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarlow M, Skeen S, Grieve CM, Carvajal-Velez L, \u0026Aring;hs JW, Kohrt BA, Requejo J, Stewart J, Henry J, Goldstone D, Kara T. Detecting depression and anxiety among adolescents in South Africa: validity of the isiXhosa patient health Questionnaire-9 and generalized anxiety Disorder-7. J Adolesc Health. 2023;72(1):S52\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdjorlolo S. Generalised anxiety disorder in adolescents in Ghana: Examination of the psychometric properties of the Generalised Anxiety Disorder-7 scale. Afr J Psychol Assess. 2019;1(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibler RC, Marzouk MA, Peugh J, Reidy BL, Ernst MM, Daffin ML, Powers SW, Kabbouche Samaha M, Kacperski J, Hershey AD, O'Brien H. Clinic-Based Characterization of Adolescents and Young Adults With Migraine: Psychological Functioning, Headache Days, and Disability. Neurology: Clinical Practice. 2024;14(3):e200294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStahl-Pehe A, Selinski S, B\u0026auml;chle C, Castillo K, Lange K, Holl RW, Rosenbauer J. Screening for generalized anxiety disorder (GAD) and associated factors in adolescents and young adults with type 1 diabetes: Cross-sectional results of a Germany-wide population-based study. Diabetes Res Clin Pract. 2022;184:109197.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Hajj S. Writing (from) the Rubble: reflections on the August 4, 2020 explosion in Beirut, Lebanon. InEssays in Life Writing 2021 Nov 29 (pp. 7\u0026ndash;23). Routledge.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Basic documents. 49th ed. Geneva: The Organization; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/adolescent-health#tab=tab_1\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/adolescent-health#tab=tab_1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Hajj S. Theorising Lebano-Pathography: A Biographical Exploration of Medical-Cultural Pathologies. Life Writ. 2023;20(4):643\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNDP. Lebanon's youth: Barriers for growth and unfolding opportunities. 2022. Retrieved from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.undp.org/lebanon/blog/lebanons-youth-barriers-growth-and-unfolding-opportunities\u003c/span\u003e\u003cspan address=\"https://www.undp.org/lebanon/blog/lebanons-youth-barriers-growth-and-unfolding-opportunities\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Yateem N, Bani issa W, Rossiter RC, Al-Shujairi A, Radwan H, Awad M, Fakhry R, Mahmoud I. Anxiety related disorders in adolescents in the United Arab Emirates: a population based cross-sectional study. BMC Pediatr. 2020;20:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMughal AY, Devadas J, Ardman E, Levis B, Go VF, Gaynes BN. A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries. BMC Psychiatry. 2020;20:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpitzer RL, Kroenke K, Williams JB, L\u0026ouml;we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire\u0026ndash;9 (PHQ-9) and the Generalized Anxiety Disorder\u0026ndash;7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZuromski KL, Ustun B, Hwang I, Keane TM, Marx BP, Stein MB, Ursano RJ, Kessler RC. Developing an optimal short-form of the PTSD Checklist for DSM‐5 (PCL‐5). Depress Anxiety. 2019;36(9):790\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrahim CB, El Kefi H, Awissawi A, Kabtni W, Baatout A, Bouizouita I, Bouguerra C, Eddif S, Oumaya A. Validation in literary Arabic among Tunisian soldiers of the Post-Traumatic Stress Disorder checklist for DSM-5. Pan Afr Med J. 2022;43:28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeong Abdullah MF, Nik Jaafar NR, Zakaria H, Rajandram RK, Mahadevan R, Mohamad Yunus MR, Shah SA. Posttraumatic growth, depression and anxiety in head and neck cancer patients: examining their patterns and correlations in a prospective study. Psycho-oncology. 2015;24(8):894\u0026ndash;900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFekih-Romdhane F, Fawaz M, Hallit R, Sawma T, Obeid S, Hallit S. Psychometric Properties of an Arabic translation of the 10-item Connor-Davidson Resilience scale (CD-RISC-10), the 8-and 10-item post-traumatic growth inventory-short form (PTGI-SF) scales. PLoS ONE. 2024;19(1):e0293079.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeronese G, Pepe A. Using the posttraumatic growth inventory\u0026ndash;short form with Palestinian helpers living in conflict areas. Meas Evaluation Couns Dev. 2019;52(3):207\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. Int J Test. 2005;5(2):159\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaalouf FT, Haidar R, Mansour F, Elbejjani M, El Khoury J, Khoury B, Ghandour LA. Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion. J Affect Disord. 2022;302:58\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarquez J, Taylor L, Boyle L, Zhou W, De Neve JE. Child and adolescent well-being: Global trends, challenges and opportunities. 2024 Retrieved from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://worldhappiness.report/ed/2024/child-and-adolescent-well-being-global-trends-challenges-and-opportunities/\u003c/span\u003e\u003cspan address=\"https://worldhappiness.report/ed/2024/child-and-adolescent-well-being-global-trends-challenges-and-opportunities/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang L, Lu M. Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiol psychiatric Sci. 2021;30:e36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897\u0026ndash;910.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Khoury-Malhame M, Rizk R, Joukayem E, Rechdan A, Sawma T. The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults. BMC Psychol. 2023;11(1):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoury-Malhame E, Bou Malhab S, Chaaya R, Sfeir M, El Khoury S. Coping during socio-political uncertainty. Front Psychiatry. 2024;14:1267603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByrd-Bredbenner C, Eck K, Quick V. GAD-7, GAD-2, and GAD-mini: psychometric properties and norms of university students in the United States. Gen Hosp Psychiatry. 2021;69:61\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHinz A, Klein AM, Br\u0026auml;hler E, Glaesmer H, Luck T, Riedel-Heller SG, Wirkner K, Hilbert A. Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample. J Affect Disord. 2017;210:338\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcynyszyn LA, McCarty CA, Chrisman SP, Zatzick DF, Johnson AM, Wang J, Hilt RJ, Rivara FP. Psychometric properties and validation of the general anxiety disorder 7-item scale among adolescents with persistent post-concussive symptoms. Neurotrauma Rep. 2023;4(1):276\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrockett MA, Martinez V, Ordonez-Carrasco JL. Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents. Rev Med Chil. 2022;150(4):458\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Res. 2019;272:30\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud MB, Ulleb\u0026oslash; AK, Plessen KJ, Bjelland I, Lie SA, Gillberg C. Psychiatric disorders in Norwegian 8-to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry. 2007;46(4):438\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiwenahisemo LC, Hong S, Kuang L. Assessing anxiety symptom severity in Rwandese adolescents: cross-gender measurement invariance of GAD-7. Front Psychiatry. 2024;15:1346267.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuzick A, Storch EA, Sm\u0026aacute;rason O, Minhajuddin A, Drummond K, Riddle D, Hettema JM, Mayes TL, Pitts S, Dodd C, Trivedi MH. Psychometric properties of the GAD-7 and PROMIS-Anxiety-4a among youth with depression and suicidality: Results from the Texas youth depression and suicide research network. J Psychiatr Res. 2024;170:237\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHughes JL, Grannemann BD, Trombello JM, Martin WB, Fuller AK, Trivedi MH. Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample. Annals Clin Psychiatry: Official J Am Acad Clin Psychiatrists. 2021;33(4):241\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeugebauer R, Turner JB, Fisher PW, Yamabe S, Zhang B, Neria Y, Gameroff M, Bolton P, Mack R. Posttraumatic stress reactions among Rwandan youth in the second year after the genocide: Rising trajectory among girls. Psychol Trauma: Theory Res Pract Policy. 2014;6(3):269.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026oacute;mez-Restrepo C, Sarmiento-Su\u0026aacute;rez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rinc\u0026oacute;n-Rodr\u0026iacute;guez CJ, Gonz\u0026aacute;lez-Ballesteros LM, Bird V, Priebe S, van Loggerenberg F. Mental health problems and resilience in adolescents during the COVID-19 pandemic in a post-armed conflict area in Colombia. Sci Rep. 2023;13(1):9743.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBou-Hamad I, Hoteit R, Harajli D, Reykowska D. Personal economic worries in response to COVID-19 pandemic: a cross sectional study. Front Psychol. 2022;13:871209. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2022.871209\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2022.871209\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Khoury-Malhame M, Sfeir M, Hallit S, Sawma T. Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon. Curr Psychol. 2024;43(13):12061\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu J, Huang Y, Liu J, Zheng Z, Xu X, Zhou Y, Wang J. COVID-19 related stress and mental health outcomes 1 year after the peak of the pandemic outbreak in china: the mediating effect of resilience and social support. Front Psychiatry. 2022;13:828379.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanchez-Ruiz MJ, El Khoury M, Doumit R, Nassar E, Wanna P, AlHassanieh M, Chaaya R, Zgheib P, Tadros N, Khalaf T, Petrides KV. Increasing emotional intelligence through Yes to Emotions in Youth (YEY): Evidence from its implementation in Lebanese public schools. Journal of Personality and Individual Differences. 2023. In Press.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, psychometric, validity, PTSD, adolescence","lastPublishedDoi":"10.21203/rs.3.rs-4486990/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4486990/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction.\u003c/h2\u003e \u003cp\u003eAnxiety is one of the major global mental health concerns, particularly amidst accumulating adversities. It is the leading cause of distress in adolescents worldwide and has a profound deleterious impact on their mental and physical health and wellbeing. This paper seeks to identify and validate the psychometric properties of the Arabic version of the GAD-7 in Lebanon, aiming to improve the much-needed overall mental health screening in Middle Eastern countries.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eThis study includes a cross-sectional design including 638 adolescents in Lebanese public schools. Participants aged 15\u0026ndash;18 years were assessed using GAD-7 (anxiety), PCL-5 (post-traumatic stress disorder), and PTGi (post-traumatic growth) in their Arabic versions at two-time points, spaced three months apart.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eOur analyses revealed that the 7 items of the GAD-7 converged into a single factor. Composite reliability of scores was adequate in the total sample (ω\u0026thinsp;=\u0026thinsp;.88 / α\u0026thinsp;=\u0026thinsp;.87). The convergent validity for this model was satisfactory. Results showed invariance across gender at the configural, metric, and scalar levels, with males showing a higher level of wellbeing compared to females. The pre-posttest assessment for the GAD-7 scale was conducted on 359 participants; the intraclass correlation coefficient was adequate 0.83 [95% CI .79; .86]. Our analyses also show that anxiety symptoms were significantly correlated with higher PTSD (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and lower PTG (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.12; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Arabic GAD-7 among Lebanese adolescents displayed highly satisfactory psychometric properties, underscoring its validity. This scale could be valuable for educators and clinicians as a screening tool to rapidly detect anxiety among this vulnerable age group as GAD-7 is easy-to-use, easy to understand, culturally sensitive for Arab population and age appropriate for 15\u0026ndash;18-year-old students.\u003c/p\u003e","manuscriptTitle":"Psychometric validation of the Arabic version of the GAD-7 among Lebanese Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-14 18:37:42","doi":"10.21203/rs.3.rs-4486990/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0692cb2f-7686-41e1-8afc-29e302bfce08","owner":[],"postedDate":"June 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-26T11:29:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-14 18:37:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4486990","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4486990","identity":"rs-4486990","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}